严晨 谢敏波 万永民 庄传记

【摘要】 目的：比较关节置换术与股骨近端防旋髓内钉（PFNA）内固定治疗老年股骨粗隆间骨折（FIF）患者的效果。方法：纳入2020年1月—2022年12月景德镇市第二人民医院收治的82例老年FIF患者，随机将患者分为置换组与PFNA组，各41例。置换组实施关节置换术治疗，PFNA组实施PFNA治疗。比较两组手术相关指标（手术时间、术中失血量、术后下床活动时间）。比较术前、术后第7天两组患肢肿胀程度。比较两组术前、术后3个月生活自理能力[功能独立性评定量表（FIM）]、髋关节功能[Harris髋关节评分（HHS）]。比较两组术后3个月内并发症总发生率（切口感染、压疮、静脉血栓）。结果：PFNA组手术时间短于置换组，术中失血量少于置换组，术后下床活动时间显著晚于置换组，差异均有统计学意义（P<0.05）。术后第7天，两组患肢肿胀程度均显著轻于术前，且PFNA组较置换组轻，差异均有统计学意义（P<0.05）。术后3个月，两组FIM评分、HHS均显著高于术前，相较于PFNA组，置换组均更高，差异均有统计学意义（P<0.05）。术后3个月，两组并发症总发生率比较，差异无统计学意义（P>0.05）。结论：在老年FIF患者临床治疗中，PFNA内固定治疗手术时间短，且术中出血量少，术后肢体肿胀轻，而关节置换术治疗术后患者髋关节功能及生活自理能力恢复更好。

【关键词】 关节置换术 股骨近端防旋髓内钉内固定 老年股骨粗隆间骨折 功能独立性 髋关节功能

Comparison of Effect of Joint Replacement and PFNA Internal Fixation in the Treatment of Elderly Patients with Femoral Intertrochanteric Fractures/YAN Chen， XIE Minbo， WAN Yongmin， ZHUANG Chuanji. //Medical Innovation of China， 2024， 21（13）： 0-069

[Abstract] Objective： To compare the effect of joint replacement and proximal femoral nail antirotation （PFNA） internal fixation on elderly patients with femoral intertrochanteric fractures （FIF）. Method： A total of 82 elderly patients with FIF admitted to the Second People's Hospital of Jingdezhen from January 2020 to December 2022 were included， and randomly divided into replacement group and PFNA group， with 41 cases in each group. The replacement group was treated with joint replacement， and the PFNA group was given PFNA internal fixation. The surgery-related indicators （surgical time， intraoperative blood loss volume， postoperative off-bed activity time） were compared. Swelling degree of the affected limb before surgery and at 7 days after surgery were compared. Self-care ability [functional independence measure （FIM）] and hip function [Harris hip score （HHS）] before surgery and at 3 months after surgery and total incidence rate of complications （incision infection， pressure sores， venous thrombosis） within 3 months after surgery were compared between the two groups. Result： The surgery time of PFNA group was shorter than that of replacement group， and the intraoperative blood loss volume was less than that of replacement group， the postoperative off-bed activity time was significantly later than that in replacement group， the differences were statistically significant （P<0.05）. The swelling degree of the affected limb in both groups at 7 days after surgery were significantly milder than those before surgery， and the swelling degree was milder in PFNA group than that in replacement group， the differences were statistically significant （P<0.05）. At 3 months after surgery， FIM score and HHS in both groups were significantly higher than those before surgery， and compared with PFNA group， FIM score and HHS in replacement group were higher， the differences were statistically significant （P<0.05）. Three months after surgery， there was no significant difference in the total incidence of complications between the two groups （P>0.05）. Conclusion： In the clinical treatment of elderly patients with FIF， PFNA has shorter surgical time， less intraoperative blood loss volume and milder swelling degree of the affected limb， but joint replacement has better recovery of hip function and self-care ability.

[Key words] Joint replacement Proximal femoral nail antirotation internal fixation Elderly femoral intertrochanteric fractures Functional independence Hip function

First-author's address： Department of Orthopaedics， the Second People's Hospital of Jingdezhen， Jingdezhen 333000， China

doi：10.3969/j.issn.1674-4985.2024.13.015

股骨粗隆间骨折（FIF）为老年人群最常见的骨折类型，且随着近年来我国人口老龄化，FIF患者逐渐增多，老年患者通常存在其他基础疾病，导致FIF治疗难度增加，临床治疗方案选择对于患者术后早期下床、髋关节功能恢复至关重要[1-2]。股骨近端防旋髓内钉（PFNA）内固定治疗、关节置换术为临床治疗FIF的两种主要方法，其中PFNA为内固定治疗，手术时间短、创口小、出血量少为其优势，但其内固定效果难以稳定，且患者髋关节功能恢复时间较长[3]。……